MEDICARE: MRS. DEBRA ANN ROADS RN, NNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WN0002X	Neonatal Intensive Care Registered Nurse	76078	CO
2	363LN0000X	Neonatal Nurse Practitioner	0001409NP	CO

General Provider Information

NPI Number	:	1427288075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DEBRA ANN ROADS RN, NNP

Provider Business Mailing Address
First Line	:	741 ADAMS ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80206-3931
Country	:	US
Telephone Number	:	303-399-8801
Fax Number	:

Provider Business Practice Location Address
First Line	:	741 ADAMS ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80206-3931
Country	:	US
Telephone Number	:	303-399-8801
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2009
Last Update Date	:	08/02/2016

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